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HomeMy WebLinkAbout020-1441-82-000 r Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division l INSPECTION REPORT Sanitary Permit No: (ATTACH TO PERMIT) 430606 0 GENERAL INFORMATION State Plan ID No. Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township Parcel Tax No: Bast, Kernon Hudson Township CST BM Elev: �J Insp. BM Elev: BM I ascri Z' Section/Town /Range /Map No 9h,l 1S 14 1V (,19 hia} 36.29.19. TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic . / i ltw-2 JD 577 Benchmark / z/.30 r 63 , 1 19- N AC Dosing — /0 / t- Alt. BM S� ) C `�$_ c Aeration l � j Bldg. Sewer 3 i g 3 i i p , 2 _ to , i ?‘, Holding S t Inlet q TANK SETBACK INFORMATIO _ � //h _ Q St/Ht Out 4/6 0 s ' /, 7,-L! g wY TANK TO . P/L WELL B DG. Vent to Air Int a ROAD Dt Inlet 3e y � �i gs-r Septic ' t O � / t -> 2 / Dt Bottom cif Dosing Header /Man. , ,Mr , ' RI s N Aeration � Dist. Pipe 1 6 0 I f 1 -0. Holding �— - ------ Bot. System • • - Final Grade PUMP /SIPHON INFORMATION 1.4® 79. f Manufacturer GPM Demand St Cover / , c /00-13 / fl 1.5 Model Nu •er TDH (Lift riction Loss System Head DH Ft Forcemain Length Dia. • . • , , e SOIL ABSORPTION SYSTEM /9/ BED/TRENCH Width / Lengt IN Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS ' ► — f3 - ' f/ 1 SETBACK INFORMATION SYSTEM TO // P/L BLDG WELL LAKE /STREAM CHAMB R anufa —7 /_, � gtez Typ- •f System: / �/ :I ` U NIT T /� / / >. / i/ 1�( / Model Numb IBUTION SYSTEM /� , � H eader/ anifo� Distribution i x Hole Size x Hole Spacing 4 r Intake Pipe(s) LL .1/1 yt2 /'1 Length 0 ' Dia Length �� , Dia ! Spacing J ' F SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only c1 Depth Over Depth Over xx Depth of xx Seeded /Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil 0 Yes [] No ril Yes [ No n COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: ( / b /o 4 Inspection #2: / / Location: 639 Leah Lane Hudson WI 4016 (NE 1/4 SW 1/4 36 T29N R19W) Cottonwood Riiddgge 1st Lot 82 P el No: 36.29.19. �� ' 1.) Alt BM Description = ` fit : CI"' WI " K Parcel la.4 0 P � �. V `/ - 2.) Bldg sewer length =3f) >Z -p a lilt � L T,Z1 13 / - f ) 91 " - amount of cover = - r2- _ ( g ` a ( - -i - r et, p l , 1071 / CirYY U la Plan revision Required? J Yes Vo Q C ' ,_,, ' r 1 6 4_ Use other side for additional information. 1 i / C "'�C �-- J — i SBD-6710 (R.3/97) Date Insepctor's Signatu e Cert. No. 1 Z% -5/64 ,-- - ` , RECEIVED V. f a nd Buildings Division County t m DEC 9 Q . a lli;tgton Ave., P.O. Box 7082 / , .A V Madi on, WI 53707 - 7082 Sanitary Permit Number (to be flled in by Co.) SCO� I (608) 261 X546 Department of Com erceS C ROIX COU�FY / /� I 0 / Op�}PdG OFF State Plan LD. Number Sani mi pplication Al A In accord with Comm 83.21, Wis. Adm. Code, personal information you provide may be used for secondary purposes Privacy Law, s I S.04(1 Xm) Project Address (if d' erent than mailing address) I. Application Information — Please Print All Information 63, 1,-Q-4 Property Owner's Name Parcel # Cali) Block # /1 -0..".. 6 4\1-' i b Property Owner's Mailing Address Loc ion /1.; City, Vs M Zip Code Phone Number r v ( (�y., Section 3 ( �� �� [ 7/ - y.-5 7 4P. r � 7 11 T tX,N; RITEorW II. Type of Building (check all that apply) n r - /� Subdivision Name CSM N b Al or 2 Family Dwelling -Number of Bedrooms ,..� S t ❑ Public/Commercial - Descnl�e Use / r 9 �7 �/ ✓► 1- ' O Yt BS h ed /O V / 1 ❑ State - escribe Use) V / Sr l- --." W // ✓ ' �-I - / v5 ❑City_❑Vil ge ii ownship of III. Type of Permit: (Check only one box on line A. Complete line B if applicable) 1 / / A. j: New System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System B List Previous Permit Number and Date Issued ❑ Permit Renewal ❑ Permit Revision ❑ Change of ❑ Permit Transfer to New Before Expiration Plumber Owner IV. Type of POWTS System: (Check all that apply) Non - Pressurized In -Ground ❑ Mound > 24 in. of siti�ab a soil ❑mound < 24 in. of suitable soli (] At -Grade 0 Single Pass Sand Filter ❑ Constructed Wetland ❑ Pressurized In- Ground Uoi' . ,c, .,z Tank ['Peat Filter ❑ Aerobic Treatmet•t Unit ❑ Recirculating Sand Filter ❑ m� . Recirculating Synthetic Media Filter ALeachi Chamber. Q Drip I .1 Gravel -less Pipe ❑ Other.' • .plain) y V. Dispersal/Treatment Area Information: __ " R r �' S rl �0 rl Area e quired ( s Design Flow (gpd) Design Soil Application Rate(gpdst) Disper� "°- . f) Sys El s 4/..7 /' VI. Tank Info Capacity in Total Number i ,, � / e) Site Steel Fiber Plastic Gallons Gallons of Units 6f 6 ' onswcted Glass New Existing CCCVVV C ( J (1 Tanks Tanks ad �-y 6i2 l � Septic or Holding Tank `1, / ! �� U / Aerobic Treatment Unit JJ �� t • . L Jv A S u a � ` "� Dosing Chamber „.. / VII. Responsibility Statement- I, the undersigned, ass += res nsi' Aty fo __ _ -- ...0 w a o he attached plans. PI s Na a Print) Plum Sign r �- ! n't PRS Number t"YJM Business Phone Number � � �,�� ZZ L e. > � 1 1 d6 o - 6 �7s Plumber's Address (Street, City, State Cod / /” — - _ c 6, 05 - il 6 iti , /41-6..i' , 7 VI . Coun /De artment Use Onl Approved ❑Disapproved Sanitary Permit F (includes Groundwater Date Issued I - ing Agent . ignatur• o '. mps) Surcharge Fee) t7 t5 • . ❑ Owner Given Reason for Denial Sd ' i 57o 4 G� �' '� C �✓A onditions o . . • . aURea ns for is pproval ' / SYSTEM OWNER. �� / " ' / l �� . , effluent filter and //� v _ D 4 dispersal cell must all be serviced / maintained I. /e ky'k) -2P�n � 0 l as per management plan provided by plumber �,// - & 4 / L f ' � i - 7y in 2. All setback requirements must be maintained ```' ¢� `N " �` ///703 as per applicable code /ordinances. ._?& a e S Soh Attach complete plans (to the County only) for the system on paper not than 81/2 x 11 Inches In size SBD -6398 (R. 08/02) 4 , . 0, -fr 1 op Jo i 3D - - g Pi - 7- y er/ i 1 / 01 T.,- '7,/,S/ 1 X ' %1. /CXD : 0-ker a� o -. e /7 5V 7"---/=- 75:Y0 q° OP 7 : % ire ooh / 4 (1 ; 1 1 \ / 5 ' • 4tr ke c 8 ff-10 /d 1( s 4 G (illjj:- 6--. --, II .l ; r a it I p4f. 5` l5.Lot I 4 ; H .4 r P r i P . . FPA P -- Po 1 t - 3D - &Pt - - T l /1/u"\11 r, 77alS / 'Q X `` i t, /9 2°141 0 r P eT 't (-A-er "\ $V r- iz. 7;y C5 * -I, ra z 16 ?'' 040 ( 4t d8 /-f-lo /) 1( m-b kJ 9s ae/rv'. *(Atik .rP 1 1/* ' - C 6—‘ �l . rA f 4 . E V '" l `2 i -' of Lp r ( eve (G1'i44. - z. TEs / -- ��G. 6, .:206'2.... Wisconsin Departr lent of commerce SOIL EVALUATION REPORT Page / of 3 Division of Safety and Bungs in accordance with Comm 85, Wis. Mm. Code County ST GRe/' X___ Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include, but not limited to: vertical and horizontal reference point (BM), direction and ✓ Parcel I.D. percent slope. scale or dimensions. north arrow, and location and distance to nearest road. Please print al -- - • • Date d Personal Mdonnation you provide be used • secondR &GE illVEtesvi. s. 1 .04 (1) (m ». ��'h ��� 4- 1 / / S /..i r Property Ovme` - P Loca K5 R,ll� $45r L Ot � 1 /4 5 /9 1 /4 S 3& T Zy N R or) W ��Cit�nn3 Property Owner's Mailing Address # - Block # Subd. Nane or CS • 99A ' MT! $4∎26- - ') 'ST. CROIX COUNTY 6 2" M# � IPA) LooQD (196-L" clty State Zip Code L... S c " - OF I_ "O City p Vliage Eq 0 Town Nearest Road L jt ..44/ . f .. /f w5D�tJ I to/ 1 5(42(P ( 715 ) % ' ' - if O0 So n) i lvilleeX a,v ) k • New Conslrudion Use: Residential / Number of bedrooms 3 -V Code derived design flow rate GPD 0 Replacement �Pubic or commerdal - Describe: 6 Parent material lDE55' Got, 51Alli y 0 Flood Plain elevation if applicable N rrr b f•. General comments p, and : "' • R''7 s % 4>+- 5v/74i3/� f ,4 /Pi Alfielvvv coNV 77o4).FL 'P. 0.44 . T. s. (j3,o £,fFvs af2 7.eev s) / 38 • 38 ' I B°'irlg ® pi t Ground surface elev. / ft. De to limii factor ��" in. Soil Application Rabe 1 Horizon Depth r Dominant Color Redox Desaiption Texture . Structure Consistence Boundary Roots GPDfir In Mknsei Qu. Sz Cont. Color Gr. Sz Sh. 'Ef101 'ESC / 0-1 zo y,p - � 5b/ r•M ccv 3f .5 . g 2- " 1 , /0 y/ 3 /L( 5/L /f 5hk "A-F i c5 If: . z . 3 3 20 :369 ye re, $/cL 1 hi �fi 45 / F . Z. . 3 H7 ,75YR s/ / G.S l An fie ds . CS — . • 7 1 •Z . or 4 d tsg J52-- "J si� V / i J /r � 4 J Pri' ° 6 l �C ' ys 6. /q ' - E Boring # pit Ground surface elev. ” • ft. Depth to limiting factor ? 90 in. Soil AppCloation Rage Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff In. Mtnsei au. Sz. Cont. Color Gr. Sz Sh. 'Ef[#1 'Eff#2 / p . /y /o Y,R 212-- - ---- -- 5 2 f shk ,►.,A -F R, cLCJ 2 f---, . -s • Se Z / 9 . 2 g --- 51L I fsl k ,►tt - f i _ ots i+ - s . r 3 18 . 33 7•sYQ 5769 -- sL D, . .wtfi', as — .3 .5 y 3g. ya ?.s ye Sly L 5 /.t y,e d,e cs . -- ' . r. 2 — , 5 (o/ dD - 7 y2 7!4 ---^ , . 0 r s c l . et L , --------- . 7 (, & / 2 • Effluent #1 in BOD > 30 220 mg/L and TSS >30 < 150 mg& * Effluert #2 = BCD, < 30 mg/L and TSS < 30 mg/L CST Name (Please Pmt) V.G'C3E2T` Z{ LAIR i atT ��15<4.- 'z-, -4 5 Address Date Evaluation Conducted Telephone Number Npu . 2 Z '= a 3 7/S. 77a,• 3 YV 2 Ulbricht & Associates Private Sewage Consultants 2812 10th Ave. Spring Valley, WI 54767 ORIG1NAL • GOB rn 2- +� # r e N oa lMs f d co/%v trooD /e/J0 �-- 3 PMpertyOwner Pmoei ID # Page of sonng 3 tit G surface .. ■ _0'� DeplhtoiI Ift. [ [ Horizon Dominant Color Rectos Texture Structure Consistence Boundary Roots GROW trs. Mu se t Qu. Sz. Cont. Color Gr. sz sh. •Eta t -Ef / 0 /o we 3/3 5/4- 2 f p e /0/A-Fi` 4,5 i f . 5 . g 7- 6•a.l IoNfie -- 511-- tf56/t 75' '.S if .2 • 3 3 .2/- L7 7 SYi€Y6( --- 5 . 2 fee 4,s / . s . 6> — 7 -s Y is' - o S� 1 /+i / tit -FR 4., . ' ; y ' • G _ oy G/2 Tor. "F -7 51G1.- 49, m,, Mi o f c' 4,C' 0. 0 S ' 3 • % J o Y A 7/6, --_ ,rtu&e . 5 or s 1 dl. I 7 P . 2 . _ J Bcdng# 0 00 u Pit Ground surface elev. ft. Depth to Roiling factor fn. Sol Applicadon Rate Horizon Depth Dominant • • Redox Description Texture Structure Come 1 Boundary Roots GPDIW in. Munson Qu. Sz. Cont. Color Gr. Sz. Sh. - 'Eff#1 4 E1f#2 1111111111111 . 1111, " 7111, , o iii , A , A , 41. d / CZ. sy , � y " /.5 oGA-T : ,Np /o ce04i uouM � D' Ss ,t, , mcl- f 4 O 4 iE? ' j — Mal N OA ..w - .: wo e y ,A$ l C .e ,4-'r "n' r O • 6X C A- *AI , - - i Cl if. evatroS ., .,.e. N -45.7 -- i .s 0. (8 . e F ae fJ S Q Pit Ground surface elev. ft. Depth , < limiting factor in. Sol Apples Rate Horizon Depth Dominant Redox Description_ Texture • •• : Consistence Boundary Roots GPM? ' in. Muns� Qu. Sz. Cont. Color G. Sz. Sh. 1 'Etf#2 1 Ad IIIKIIIIIIIII 11111111111111111111111111 IIIIIIIIIIIIRMIIIIMIIIIIIIIIIII 11111 A 1 i , # 0 Boring 0 Pit Groundscu'face efev. ft. Depth fio hitting factor in. Sof Application Rate ttorrzon # Depth Dominant Color Redox 4 :. • '� : • • . Texture Structure fence Boundary Roots GPDNE ■ i M. Munsell Du, Sz. Color Gr. Sz. Sh. *Oil 1Eii#2 • Effluent #1 = soo > 30 < 220 • and TSS >30 < 150 mg& ' Effluent #2 = B00,130 mglt. and TSS < 30 mg/ L. The Department ofConunerce is an equal opportunity service provider and employer. If Yon need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608- 264 -8777. $eo -Saw (Rma) i f O >' $tM 41 2- , Ta1 of 5/( tri ' 1 a ..11 br)js Lo T 7 Li 005 No• to r • t. y ' -e- GiNI,' / 1 131 7 oU vy • .— Zy ., 50 ,e oeyok ' ,00,0` 1 110 Ulbricht & Associates ► ca Private Sewage Consultants 2812 14th Ave. /2‹ Spring Valley, WI 54767 ,N , f g i ii0 0 • • / , C---- 00.5 r L''. ..e3 , /oo . / 3 4 , A.}(z,u, , a \\ /od, SO •� • u) s Gill-e- : / 3 Q ti, v) • _ $,#c /a' P/r5 � � ,�� G�.��CS' For issuance of permits and designing Contact: Ulbricht & Associates Registered private wastewater consultant and ply 2812 10th Ave. Spring Valley, WI 54767 715- 772 -3442 So , Gv T d- i:v --e- — ijoyik ; Devito ofrie : A-ERiON /3/15r 3 no,vN,t sPE /3„0 r 9 y� 1 4- L31r ?G-E- RP • 1/1421oA', w/. s Wisconsin Department of Commerce SOIL EVALUATION REPORT / 3 of Division of Safety and Bulldogs in accordance with Comm 85. Ws. Mm. Code Cw " t Y 5T 6/2otx— Attach complete site plan on paper not less than 8 1/2 x 11 inches In size. Plan must Include, but not limited to: vertical and horizontal reference point (BM), diredion and Parcel 1.0. 5 e.. /3.e./6 w 4- percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Please print a Reviewed by • Date Personal Information you provide may be used secondalg6 ( ew, s. -.W (1) (mil. Property Owner , P . 4(1/ y Location 7.J E OF Slit Asidt- iVEi'G /LGdXSO,v 3 9 7nr>3 s36 9 . /7 If (or)W Lot s� 1/414 S3 T.2 N R Property Owner's Mailing Addr J t # Blodc # Subs(. N or CSM# 1tVi$ T �7 rzi./p! /.& cry. �. /V w r Gi :01X COUNTY i C 1/ l e , / t - o 6 iG� L b Pee Cty State Zip Code cM"'1•'': City ❑ Viflage )Town Nea dad //VPSO W /. � S0i4 (7 3 r 4'yose •) • i t y N • 0 Construction Use: (Xl Residential / Number of bedrooms 3 - y Code derived design flow rate y cc, - C' an GPO ❑ Replacement ❑ Public or commerdal - Describe: Parent material 42:35 'OE TIpO D *i .G_. '7//75 Flood Plain elevation if applicable N �� - - ~ -- fl. General comments 5E4"SD.v4 //V S,4 r7A4 a f - , , and recommendations: • A l e c , ¢ 7 s 77D 3 t ) 7 4 1 3 1f ' r o r b 4- Ld v6-- 4v10'/Vo2J Mov.op ss ys r. / z " ( s- ❑ Bodng , ,,.. sss Borin # / ® Pit Ground surface elev. ft. Depth, to uniting factor in. Soil Apps Rate Horizon Depth Dominant Color Redox Descriptfon Texture Structure Consistence Boundary Roots i GPDff in. Munsel Qu. Sz. Cont. Color Gr. SL Sh. I 'Eff#1 'EMU / b./9 / o YR3 /3 G /f Ala fie cv / r" • q . C� 9 - - /y20 /D y/2 3/ L /isle 4.0 lay ceo / f • 9 .6. 3 .20 •;f /oy,' /// siL / fs4c - e5 / f . 2.. . 3 /D ' fir pro >' — 5/ L 21 /144--/A7 C/ -- .5 - 5 35 • ?p �5 .� cad pro rs SG /I fie 4M-&' _ -- - Sy/2 # ❑ Boring ss Z I� 1K1 Pit Ground surface elev. 9 " ft. Depth to limiting factor 25 in. Sod Appflcadon Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDfl1 In. Munsetl Qu. Sz. Cont. Color Gr, Sz. Sh. •EA#1 'ER#2 1 o / /o R3/3 — L hes 444 {se w /7 . _ • eo id. /6g•3 / ----- 1 /f 5 1 4 04) / t .� 3 T-2-5 /a ) /fsI,c 4.$) - — . 2 .3__ D , - Fl - f Na 1 s S / / f5,4e M'' �/ C4) -- . 2- r r Z — S 3G'7i�• y e fioTs S- /fye / • y • C 6Y (/L • Effluent #1 = BOD > 30 < 220 mgll and TSS >30 < 150 mg& • Effluent #2 = BOD < 30 mgl& and TSS < 30 mgt. CST Name(Please E R r f /h�i C11 j� S r'IJ 6� 2 Number 5 Address Date Evaluation Conducted Telephone Number Utbricht .q, Associates Dec . Ce - Zp D Z✓ 7/5.3 <96. VS'S r TI vate 055 O'Neil Rd. Hudson, Wis. 5401(1 .. Pi/ /vi a� SI� a(2 •/ /o?•ya• eyero • SE o f No old - / /D9.2 0 - Caro . K , v . /3�s 6 " Go f # /? 03.o•! /oy. yo• oav Property, Owner /V. L tot( 0 X SD O).0 • //b ry • 10 • 2 Parcel ID # Page of 3 I Ong# Q /Q 3� it Ground surface elev. 4 7 • ` v ft. Depth to limiting factor in. Horizon Soil Application Rate Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell• _ Qu. Sz. Cont. Color Gr. Sz. Sh. • •Eff#1 'Eff #2 0 13 / 3/3 1 / /sly nom fie c 70 2 7 V 16 2- /3.-2 /49y/ a /z- — s/L I Ps* fie c/ i / . Z • 3 3 2 • .3 /0 3/ <s/i 2 irs4e cze.) . • •► 1 , r5 2 � , . , >c' — . S 7- y $ So . 0' /Oy/ ez ae MOTS 5 /CZ- / f 4 Vii ---- - _ • 3 yR Boring #, ❑ Boring . L] Pit, Ground surface elev. ft. Depth to limiting factor Jn. Sod Application Rate Horizon Depth Dominant Color Redox Description Texture • Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2 # o Bring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Horizon Depth Dominant Color Redox Des Soil Application Rate Description. Texture Structure Consistence :. ndary Roots GPD/ff in. Munsell Qu. Sz Cont. Color Gr. Sz. Sh. •Eff #1 •Eff#2 • • t 1 �# 0 Born ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description. Texture Structure • istence Boundary Roots GPD/ff In. Munsell _ Qu. Sz Cont Color Gr. S = . •Eft#1 •Eff#2 • • Effluent #1 = BOD > 30 < 220 mg/l- and TSS >30 < 150 mg/l- • EQluent #2 = BOO. < 30 mg/l. and TSS < 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608 -264 -8777. S8041330 (1116/00) • r For issuance of permits and designing Contact: Ulbricht & Associates Registered private wastewater consultant and plumbers 655 O'Neil Road Hudson, WI 54016 715 - 386 -8185 or 715-772-3442 t sc 9/5 / "-= 30 . s = /3.gcKiete Pi %S 6, = lo,4 u/ e., 64' L) .*T'o, ) L./;t S L ° T /8 :--- --' Top o f �� uo-e- fill) . � r 4- 2 ' pill" P s 9 I/ , 7 \ . 7 07 * we 44 r 4 ... 1 \ 0 3 q0 116 f b ?7�U /foie/` ll e0 G7 \...______— 5 y5 r &A,1 to c)foWe \ i 9 7. / d I 2-----. I \ 130 ,,, • p,3 ,� Ili s sr f'1avti� sy5r- &�, wi "tt.. i�'' g ill S Au v at A 9 g,ig A a � a 1 " ET : Top °F 6- 5-("1 13e1 #i� � f , If" A /3o ut. 90) - 3a /00, 0 - FUt — 5o. Lon 1 . ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM OwnerBuyer ezeNeW Mailing Address 9 % / -' Property Address w ' ' • (Verification required from Planning Department for new construction) %1 City /State / /.ra Parcel Identification Number / 3.01- , (1/W■e-,6 - ~ LEGAL DESCRIPTION Property Location Al L 1/4, 5 1/4, Sec. 3 Co, T N -R W, Town of Jl/LL/� Subdivision o % v:/ °P/G � i /O / 7707 j Lot # Certified Survey Map # , Volume , Page # Warranty Deed # ? 0 ca n O , Volume 3- / 3 5 , Page # 35 . Spec house es ❑ no Lot lines identifiable yes ❑ no ,SYSTEM MAINTENANCE 1 15 E / yl�G Improper use and maintenance of your septic systeht could result in its premature fa han ties. Prop maintenance consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 days of the three year expirati s , date. s fir /01 03 GNATURE OF " ' ' ICANT DATE OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of the property described abov by virtue of a warranty deed recorded in Register of Deeds Office. •^ ,, /ZJ l IGNATURE OF APPLICANT DATE * * * * ** Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department. * * * * ** ** Include with this application: a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed Saturday, December 13, 2003 7:51 AM Tom McCabe 651- 351 -1019 p.02 0 $ • w 1 e I 1 __ 1 1 1 = \ 1 t e I 11 }. 1 ®UN. Y 1 _. r _f 7� s 1- _ _ f lla' 1 ! 1 ■ -- 1 h ' 1 1 ?lia - •1 r 1 I F'� 1 G���fh I :: aar.�a 1 1 1 - 1 1 r aztwo - 1 A $ __ 1 xaasl= q 1 1 a 1 y ar�ati s �r 1 ` '► ' �F 1 � _. I X ,--r� 11 �X1a" i � f � � � �I ca ."- ,`, l> i �' R � 1, r% Ig e 1 a i m i 1 R 74. j r V 16 .. ` � = 4 rr 1 f - � 1 � - - - - J L. rwri '! r -- -____I L_ -- — c 1 S � ; ` - z 4 I r -u r H e 1 • b tl i L r� I 6 • d L 1 to 1 1 .1 NI. . N (fl M as - +W ■ 4 a� r N 1Y■ POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page ' of 2 . FILE INFORMATION SYSTEM SPECIFICATIONS Owner 1J f� Septic Tank Capacity /a 5-0 ga l ❑ NA Permit # j /� 30 (' Septic Tank Manufacturer / � � ❑ NA '' j % n DESIGN PARAMETER Effluent Filter Manufacturer G��V� . ❑ NA Number of Bedrooms f p� ,i� __:a NA Effluent Filter Model -/D0 ❑ NA Number of Public Facility Units k ( ❑ NA Pump Tank Capacity ga t ANA Estimated flow (average) I/O 0 gal /day Pump Tank Manufacturer ❑ NA Design flow (peak), (Estimated x 1.5) 60 d gal /day Pump Manufacturer ❑ NA Soil Application Rate 7 ga / day /ft� Pump Model • ❑ NA Standard Influent/Effluent Quality Monthly average* Pretreatment Unit NA Fats, Oil & Grease (FOG) 530 mg /L ❑ Sand /Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BOD 5220 mg /L ❑ NA ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) 5150 mg /L ❑ Disinfection ❑ Other: Pretreated Effluent Quality Monthly average Dispersal Cell(s) ❑ NA Biochemical Oxygen Demand (BOD 530 mg /L 156n-Ground (gravity) ❑ In- Ground (pressurized) Total Suspended Solids (TSS) 530 mg /L NA ❑ At -Grade ❑ Mound Fecal Coliform (geometric mean) 510` cfu /100m1 ❑ Drip -Line ❑ Other: Maximum Effluent Particle Size Y8 in dia. ❑ NA Other: ❑ NA Other: ❑ NA Other: ❑ NA "Values typical for domestic wastewater and septic tank effluent. Other: ❑ NA MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once every: ❑ month(s) p2 � year(s) (Maximum 3 years) ❑ NA Pump out contents of tank(s) When combined sludge and scum equals one -third ()S) of tank volume ❑ NA Inspect dispersal cell(s) At least once every: year( jlsl (Maximum 3 years) ❑ NA Clean effluent filter At least once every: / zyearts)(s) ❑ NA ❑ month(s) ❑ NA Inspect pump, pump controls & alarm At least once every: ❑ year(s) ' ❑ month(s) ❑ NA Flush laterals and pressure test At least once every: ❑ yearls) Other: - ❑ monthls) ❑ NA At least once every: ❑ year(s) Other: ❑ NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or Teaks, measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one -third (1 or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113, Wisconsin Administrative Code. All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, and any servicing at intervals of 512 months, shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. Page Z of ?� START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals that may impede the treatment process and /or damage the dispersal cell(s). If high concentrations are detected have the contents of the tank(s) removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and may result in the backup or surface discharge of effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at -grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS fails and /or is permanently taken out of service the following steps shall be taken to insure that the system is properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or.must be taken, to provide a code compliant replace nt system: A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. ❑ A suitable replacement area is not available due to setback and /or soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. f J alua •• ' • • _ a o • mg tank • • b: • • - . r.1.` " a1 e. ' • • ?1D441$ rre:b. )19-- / I6W vs R(JC fl Of.l ❑ Mound and at -grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. «WARNING» > SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND /OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. • ADDITIONAL COMMENTS • • POWTS INSTALLER POWTS MAINTAINER Name � Name Phone 7/5 ] / y p'� Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Name r, C2o y (bUldrY p 2&JM� J6- Phone Phone "�l s 3'(— 4/0 p o This document was drafted in compliance with chapter Comm 83.22(2)(b)(1)(d) &(f) and 83.54(11. (2) & (3), Wisconsin Administrative Code. • J 2 1 3 S P 3 5 5 7CD88812) • WARRANTY DEED KATHLEEN H. DE ED REGISTER OF DEEDS ST. CROIX CO., VI Neil L. Wilcoxson and Mary J. Wilcoxson, a /k/a RECEIVED FOR RECORD Mary Jo. Wilcoxson, husband and wife, conveys 02/07/2003 02:00PM and warrants to Kernon J. Bast the following EXEMPT 11 described real estate in St. Croix County, State of REC FEE: 11.00 Wisconsin: TRANS FEE: 2880. COPY FEE: CERT COPY FEE: PAGES: 1 Exception to warranties: all easements and restrictions of record. This is not homestead property. Parcel Identification Number(s): 20- 1109-40 -000; 20- 11 -9 -20 -000; 20- 1109 -10 -000; and 20- 11 -90 -55 -000 Name and y�n to Wealty rs. TO: A parcel of land located in part of the Southeast 1 /4 of the t ` Cina Title Northwest 1/4 , part of the Southwest 1/4 of the Northwest 400 South 2nd Street 1/4 , part of the Northeast 1/4 of the Southwest 1 /4, and part Suite #115 of the Northwest 1 /4 of the Southwest' /., all in Section 36, I , kty>�lson, WI 54016 �� Township 29 North, Range 19 West, Town of Hudson, St. ' "l / d' Croix County, Wisconsin described as follows: Commencing at the South' /. corner of said Section 36; thence North 00 degrees 10 minutes, 01 seconds West along the north -south % line, 1634.77 feet to the Northeast corner of a parcel of land described in Volume 526, page 259 at the St. Croix County Register of Deeds Office, being the point of beginning; thence continuing North 00 degrees, 10 minutes, 01 seconds West along said North -South 1 /4 line, 1977.22 feet to the South line of the North 350 feet of said Southeast 1/4 of the Northwest 1 /4; thence South 88 degrees, 49 minutes, 51 seconds West, along said South line and the Westerly extension of said line, 1324.14 feet; thence South 00 degrees, 09 minutes, 43 seconds East 2,096.73 feet to the centerline of County Trunk Highway "N" being a point on 1,999.00 foot radius curve, concave southerly, whose central angle measures 03 degrees, 00 minutes, 19 seconds, whose chord bears South 80 degrees, 02 minutes, 21.5 seconds East and measures 104.84 feet; thence Easterly, along the arc of said curve and centerline, 104.85 feet to the point of tangency; thence South 78 degrees, 32 minutes, 12 seconds East along said centerline, 712.54 feet to the West line of said parcel described in Volume 526, Page 259, thence North 00 degrees, 10 minutes, 01 seconds West along said West line 304.75 feet to the North line of said parcel; thence North 89 degrees, 49 minutes, 59 seconds East along said North line 523.00 feet to the point of beginning, all in Section 36, Township 29 North, Range 19 West, St. Croix County, Wisconsin. /l.. Dated this � 1 � t day of _Jl1 -rGG/ , 2003. 7,,,, ‘,„",..),, 'I L 'Wiicoxson Mary J. WSJ t#a ACKNOWLEDGMENT . �"'�''1,''iti�, STATE OF WISCONSIN ) ,:Y P(/S, COUNTY OF ST. CROIX ) / O � J � Personally came before me this -3.4' h is�� day of /1�I ( the above • :med Neil L. Wilcol d Mary . 7 Wilcoxson to me known to be the persons who executed th foMg� oing instrum - . acknowledge the 'ime D EBoRAH A. * _ 4 PRESTON Nota Public br1 My commission expires: b - /� h l/ 9� C O Q = This instrument drafted by Robert F. Wall. WilcoxsontoBastWD03 -1 h OF WIS t. Saturday, December 13, 2003 7;51 AM Tom McCabe 651- 351 -1019 P.01 FA1C ATTN. Pam Quinn Fax Number 101063617153864686 Phone Number FROM Tom McCabe Fax Number 651 - 351 -1019 1 Phone Number 651 - 351 -1018 SUBJECT Plan revise Number of Pages 2 Date. 12/13/2003 MESSAGE Pam, The following is the corrected page for plan 03 -629. Any questions please call me at 6513511018. Thanx. Tom Tuesday, December 09, 2003 5:00 PM McCabe Homes, Inc. 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A% Z r0 -+ 00 117-i\ - El o P m m - ri o § i + RRHffl of b I l Q N v Z 0000E1 I I —1" .' r 2� .� -000® = `f ` i ir + 1 FR m_ 1111421- -----/ -1 N — INE.. ,, - . liii.E. 11111111111€: / m lim 11 1 I § - - _ o _ o ®l — r t -[I :, \ p i '�� 1111.!"- -II_ z / 0 A • ° W Z x• -per //; N .s RESIDENCE FOR: ? > P t A N CO 13UPMINC�1-IAM F 6, 1 tin Mc C 4 E i-IOt tES b U... • • Ewa, aroma sue • ,s.,. Tuesday, December 09, 2003 5:00 PM McCabe Homes, Inc. (651)351 -1019 p.01 ATTN. Pam Quinn Fax Number 101063617153864686 Phone. Number FROM Tom Mc Cabe Fax Number (651)351 -1019 Phone Number (651)351 -1018 SUBJECT Plan you requested Number of Pages 6 Date. 12/9/2003 MESSAGE Pam, The following is the plan you requested from Planco, Inc. The only missing page should have been the cross section, page 5. Any questions please feel free to call me. Thanks. Tom McCabe 6512487055 258.50 1 VV � BENCHMARK -------- 1036.5 2" IRON PIPE FOUND �¢ 418.30' I - - - . - . ELEV..= .1035.13 p 33' 33' USGS DATUM 1929 I- ®4 X • • I • (y X TEMPORARY CUL DE UPON EXTENSION OF 1037.3 N 1 034.9 OF COTTONWOOD RU 1035.9 1 w NI • 1- W o . co o 3 LOT 20 - N d04 Z." 2.16 ACRES • 94285 SQ. FT. • _ rn X 0 (2.16 AC.) 1036.0 11 • LOT 17 k • 1 . 2.08 ACRES 6 6' iX 90639 SQ. FT. ' 11M.7 (2.08 AC.) • • co X x N • 1 1038.2 1035.7 • 1036.2 c • \ 1037.0 • X X lalb■ . 80 ' Rgplu ® 1039 `:,. _ 8' • N89 °55'21 "E 205.13' c•5 �_l�4 _* \ 01/ • 1035.5 Mill • J X 0 • X 1 • • . • 1036.6 n 0 � 2.1� 'CR. d O O '1694 • Q. D Z © • .10 .) LOT�10 ■ 2.23 ACRES 1036.4 1041.1 ° 96940 SQ. FT. o ® (2.23 AC.) X 0 O • X Ili F ~, [1.r 4 vi N 01 1052.9 1038.4 0 X • X �� ■ X O 1037.3 X i_ 1038.7 <1 ♦ J I 24 .50 89 °49'5" "E , • e • a l 281. '� aim 1111•• y�,�.a� ,,o.. ar �► T r::s� 23.50, $'-. 00 o 1 \ X 1038.6 ) 0 T 1 O 8 ---( 0.12 ACRES [LOT 2 , 5230 SQ. FT. i .` 43 i 1039.1 MN 04HEG3� _ pA N@ L F Erl; v��V 1m.. 26 Pao 2gg Imam i e • 10 X.1 t 1040.8 ALU .. S CO' i k 1" , 1 r 1 `� x � 0 1. L x 1044.7 X PC { 10 LC )T 1 " OI �\ � tr : NCHMARK > �r i • • PIPE FOUN � 1 15/1 �,��v-� 1 "I - EV. = 1cgs,. i O • t- _` x.....____USGS DATUM 1929 1 LOT81 2.08 ACRES 6 6' ' 0 I ' 90,623 SQ. FT. t ii 20 • • 1)f \`16 tri 1 1 : N89 °55'21 "E 205.00' • \ 15 � n • C) 18 • in O 1 CD 83 DES g LOT 82 E E D. FT. 0 2.23 ACRES ir9 O a 96,934 SQ. FT. `° o m O LOU' 0 O © © a 1 N89 °49'59 "E 523.00' 281.50' �g — — 241.50' D N89 °49'39 "E 523.00' 8 OUTLOT 2 0.12 ACRES � 5230 SQ. FT. WEE ILL\0 OWW IAFO 1131 OtUMEG NOTE: OUTLOT 2 IS TO BE DEEDED TO AN ADJOINING LANDOWNER. 1 ECU 'fl �_ BENCHMARK 1" IRON PIPE FOUND �_ _ �„ ELEV. = 1050.47 ../ i� �_ USGS DATUM 1929 t - n' . N- o 4 o